Individual
MISS LISA-GAYE CAMILLE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(248) 747-2125
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(248) 747-2125
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301099382
MI
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
24942
MS
Other
Enumeration date
07/25/2011
Last updated
08/28/2017
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